The American journal of medicine
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Multidrug-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), are endemic in healthcare settings in the United States and many other countries of the world. Nosocomial transmission of MRSA serves as a source of hospital outbreaks, and recent reports of vancomycin-resistant S aureus strains in the United States emphasize the need for better control of MRSA and other resistant bacteria within healthcare settings. Colonization with S aureus or MRSA is relatively common in both healthy and hospitalized individuals, most often involves the anterior nares, and is frequently asymptomatic. ⋯ Currently, the efficacy of many of these individual infection control interventions remain in doubt. Many studies reporting improvement in infection control outcomes (e.g., reduced transmission, decreasing prevalence) involve simultaneous institution of several of these measures, making it impossible to tease out the effects of any of the individual components. Nonetheless, the best approach in the current environment probably involves hand hygiene plus a careful assessment of an institution's particular circumstances, applying more aggressive procedures such as patient isolation, staff cohorting, and active surveillance cultures, as indicated.
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Fear of muscle toxicity remains a major reason that patients with hyperlipidemia are undertreated. Recent evaluations of statin-induced rhabdomyolysis offer new insights on the clinical management of both muscle symptoms and hyperlipidemia after rhabdomyolysis. The incidence of statin-induced rhabdomyolysis is higher in practice than in controlled trials in which high-risk subjects are excluded. ⋯ The evaluation and treatment of patients' muscle symptoms and hyperlipidemia after statin rhabdomyolysis are presented. Patients whose symptoms are related to other disorders need to be identified. Lipid management of those whose symptoms are statin-related is reviewed including treatment suggestions.
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Review
Approaches to patient education: emphasizing the long-term value of compliance and persistence.
Approximately 50% of patients with chronic disease do not obtain optimal clinical benefit from treatment because of poor compliance with medication regimens. Lack of compliance is associated with poor clinical outcomes, increased hospitalizations, lower quality of life, and higher overall healthcare costs. Although poor compliance and persistence are common across many disease states, they may be particularly poor in treatment for asymptomatic chronic diseases such as osteoporosis. ⋯ Patient satisfaction with treatment has been linked to compliance with therapy; by improving patient care through fulfilling expectations for physician visits and providing frequent feedback, the healthcare provider can dramatically improve compliance. Self-management programs focusing on day-to-day management of chronic diseases have been shown to significantly improve heath behaviors and health status. Regardless of the strategy used, attention must be directed to identifying the patients least likely to persist with treatment and to providing the education and support these patients need to adhere to osteoporosis therapy.
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Hypothermia-related cases typically occur after exposure to low ambient temperatures; however, numerous cases occur in individuals with no history of exposure to cold environment. Hypothermia is associated with such complications as acidosis, impaired myocardial function, bleeding diathesis, and decreased kidney and liver function. ⋯ The choice of rewarming therapy is based on the degree of hypothermia. The evaluation, electrocardiographic manifestations, and management of hypothermia are reviewed.
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Review Meta Analysis
The incidence of stroke after myocardial infarction: a meta-analysis.
While the risk of stroke after myocardial infarction (MI) is increased compared with the risk among those without MI, the magnitude of this risk remains unclear. Although numerous clinical trials have reported the incidence of stroke following MI, these are among selected populations. We reviewed cohort studies reporting the incidence of stroke after MI to better define the risk of ischemic stroke in an unselected population. ⋯ The public health implications of stroke among MI survivors, as well as the large number of MI survivors, underscore the need to be aware of this devastating complication. Further research is needed to determine the optimal stroke prevention strategies for MI survivors.